Workers' Compensation Claims Adjuster I

EMC Insurance Companies

5d • Remote

About The Position

At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together. Position is eligible to work from home anywhere in the US.

Requirements

• Bachelor’s degree or equivalent relevant experience
• One year of workers’ compensation claims adjusting experience or related experience
• Attainment of all applicable state licenses within one year of hire
• Working knowledge of the theory and practice of the claim function
• Good knowledge of insurance contracts, medical terminology and substantive and procedural laws
• Ability to adhere to high standards of professional conduct and code of ethics
• Strong knowledge of computers and claims systems
• Strong organizational and written and verbal communication skills
• Good investigative and problem-solving abilities
• Occasional travel required; a valid driver’s license with an acceptable motor vehicle report per company standards required if driving

Nice To Haves

• Relevant insurance designations preferred

Responsibilities

• Independently investigates, evaluates, negotiates, and resolves workers’ compensation claims within authority guidelines; communicates with insureds, agents, and partners on coverage, status, and inquiries
• Investigates and evaluates claims, verifying coverage, jurisdiction, and compensability
• Initiates timely contact with insureds, claimants, and relevant parties to explain the claims process
• Gathers statements, documentation, and official reports; documents all file activity and updates claim records
• Sets and adjusts reserves in line with company guidelines
• Reviews medical treatment, billing, and wage data to determine appropriate benefits and payments
• Coordinates medical care and return-to-work efforts
• Identifies and pursues subrogation and recovery opportunities
• Ensures timely statutory notifications and compliance with jurisdictional requirements
• Monitors claim progress and escalates complex claims as needed
• Prepares settlement evaluations, strategies, and negotiation targets
• Investigates and resolves compensability and coverage issues
• Negotiates settlements and collaborates with attorneys; attends mediations and conferences as needed
• Issues settlement documentation and payments within authority limits
• Provides clear, timely claim status updates to insureds, agents, and claimants
• Ensures compliance with all state reporting and documentation requirements
• Collaborates with internal teams (SIU, Subrogation, Medical, etc.) and supports team members
• Submits referrals and promotes programs such as return-to-work and preferred provider networks
• Assists with account servicing and marketing efforts as needed
• Maintains licenses/CEUs and completes ongoing training on regulatory and medical updates

Benefits

• life, medical, dental, vision and prescription drug coverage
• Competitive paid time off plan
• full day of volunteer time off annually
• 401(k) plan match
• pension plan
• OneEMC bonus plan
• recognition and anniversary awards
• Professional development and growth opportunities
• tuition reimbursement
• Wellness initiatives to improve team member well-being and reduce health insurance costs

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree